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University of Otago

1. Lin, Sylvia. The Relationship of Obstetric Factors to Aspects of Pelvic Floor Trauma And Dysfunction 20 Years Post-delivery .

Degree: University of Otago

Background The pelvic floor (levator ani and covering endopelvic fascia) has an important role in supporting the bladder, vagina, uterus and rectum. Pelvic floor trauma in women may result in urinary and faecal incontinence, and also pelvic organ prolapse. It is a very common problem affecting around half of women having at least one type of pelvic floor dysfunction, particularly later in life. The aetiology of pelvic floor dysfunction is likely to be multifactorial, although childbearing is probably the most significant predisposing factor in women – vaginal delivery resulting in stretching and avulsion of levator ani muscles, damage to anal sphincter, along with nerve trauma are important factors.The development of functional imaging has revolutionised our understanding of the pelvic floor during and after birth. There is however a lack of information on the long-term relationship between obstetric factors with pelvic floor trauma and the relationship between these obstetric injuries and long-term pelvic floor function. Objectives To investigate the relationship between obstetric history and the clinical and ultrasound diagnosis of levator avulsion (LA) and damage to the anal sphincter 20 years after childbirth. We also aimed to examine the relationship of these obstetric injuries to symptoms and signs of pelvic floor dysfunction and to compare digital palpation of LA with ultrasound diagnosis. Design Twenty-year longitudinal study. Setting Maternity unit in Dunedin. Population Women dwelling in the community. Methods Data from women were collected 20 years after an index birth by postal questionnaire, and women were invited for examination and ultrasound assessment. Logistic regression investigated associations between ultrasound diagnoses and symptoms and signs of pelvic floor dysfunction. Main outcome measures Objective measures of prolapse (POP-Q) and ultrasound confirmation of LA and obstetric anal sphincter injuries (OASIS). Subjective report of pelvic floor dysfunction measured by the pelvic organ prolapse symptom score (POP-SS), Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) score, any urinary and faecal incontinence. Results Of 1248 women at initial recruitment, 1191 questionnaires were sent and 464 (39%) returned questionnaires at 20 years. 196 of these returned for clinical assessment. The mean age for the examined respondents was 50.8 years. The overall LA rate was 15.2% and OASIS rate was 12.5%. Agreement between palpation and transperineal ultrasound diagnosis of LA was 91% (kappa 0.32). Forceps delivery was associated with significantly greater LA rate compared with vaginal delivery (26% vs. 13%, OR 2.45, 95% CI 1.04-5.08, p=0.04); as well as higher OASIS rate but that did not reach significance (21% versus 11%, OR 2.2, 95% CI 0.87-5.59, p=0.098). LA was significantly associated with more objectively measured POP-Q, “bothersome” prolapse and faecal incontinence, but had no association with prolapse symptoms by POP-SS. LA was significantly associated with… Advisors/Committee Members: Wilson, Don (advisor).

Subjects/Keywords: urogynaecology; new zealand; Dunedin; ProLong study; pelvic floor; pelvic floor dysfunction; pelvic floor trauma; levator ani; levator avulsion; puborectalis avulsion; OASIS; obstetric anal sphincter injuries; pelvic organ prolapse; urinary incontinence; anal incontinence; faecal incontinence; POP-Q; translabial ultrasound; transperineal ultrasound; sexual dysfunction; PISQ-12; obstetric practice; forceps delivery; obstetric factors; delivery; childbirth; caesarean; instrumental delivery

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APA (6th Edition):

Lin, S. (n.d.). The Relationship of Obstetric Factors to Aspects of Pelvic Floor Trauma And Dysfunction 20 Years Post-delivery . (Masters Thesis). University of Otago. Retrieved from http://hdl.handle.net/10523/6707

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Chicago Manual of Style (16th Edition):

Lin, Sylvia. “The Relationship of Obstetric Factors to Aspects of Pelvic Floor Trauma And Dysfunction 20 Years Post-delivery .” Masters Thesis, University of Otago. Accessed December 05, 2019. http://hdl.handle.net/10523/6707.

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MLA Handbook (7th Edition):

Lin, Sylvia. “The Relationship of Obstetric Factors to Aspects of Pelvic Floor Trauma And Dysfunction 20 Years Post-delivery .” Web. 05 Dec 2019.

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Vancouver:

Lin S. The Relationship of Obstetric Factors to Aspects of Pelvic Floor Trauma And Dysfunction 20 Years Post-delivery . [Internet] [Masters thesis]. University of Otago; [cited 2019 Dec 05]. Available from: http://hdl.handle.net/10523/6707.

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Council of Science Editors:

Lin S. The Relationship of Obstetric Factors to Aspects of Pelvic Floor Trauma And Dysfunction 20 Years Post-delivery . [Masters Thesis]. University of Otago; Available from: http://hdl.handle.net/10523/6707

Note: this citation may be lacking information needed for this citation format:
No year of publication.

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